Thanatophoric Dysplasia Workup

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Luis O Rohena, MD  more...
 
Updated: Sep 07, 2016
 

Laboratory Studies

The following studies are indicated in suspected cases of thanatophoric dysplasia (TD):

  • Chromosome analysis (karyotype) to determine the presence or absence of chromosomal abnormalities.
  • DNA molecular testing for FGFR3 using targeted and sequence mutation analyses.

A study published in 2015 by Chitty et al suggested that next-generation sequencing (NGS) is more sensitive than polymerase chain reaction assay and restriction enzyme digest (PCR-RED) in the prenatal diagnostic screening for monogenic disorders, including thanatophoric dysplasia and achondroplasia. In the study, which used cell-free DNA from maternal blood, NGS and PCR-RED were performed to aid in the prenatal diagnosis of thanatophoric dysplasia and achondroplasia, with NGS being 96.2% accurate, compared with 88.6% for PCR-RED.[6]  

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Imaging Studies

During the second or third semester of pregnancy, prenatal ultrasonography[7, 8] and CT scan assessments may be diagnostically helpful, as follows:

  • Two-dimensional (2D) ultrasonography reveals polyhydramnios, growth deficiency, ventriculomegaly, a narrow thorax, flattened vertebrae and micromelia
  • Three-dimensional (3D) ultrasonography may reveal the fetal face, scapular anomalies, and chest hypoplasia better than 2D ultrasonography
  • A study published in 2014 by Wang et al indicated that the prenatal identification of temporal lobe dysplasia by ultrasonography may aid in the identification of thanatophoric dysplasia; the study found that out of 24 cases of thanatophoric dysplasia, 16 (67%) demonstrated ultrasonographic evidence of temporal lobe dysplasia[9]
  • Prenatal 3D CT scanning may complement ultrasonographic findings in cases in which fetal skeletal dysplasia is suspected, but no specific diagnosis can be made using ultrasonography alone; further studies on clinical performance and risk-benefit analysis are needed before 3D CT scanning is incorporated into standard practice guidelines[10]

Postnatal radiography and other imaging studies (CT, MRI) may reveal the following:

  • Enlarged skull and a small foramen magnum with potential evidence of brain stem compression
  • CNS abnormalities such as hydrocephalus, brainstem hypoplasia, temporal lobe malformations, neuronal migration abnormalities
  • Flattened vertebral bodies (platyspondyly) with wide intervertebral spacing
  • Rhizomelic shortening and irregular metaphyses of the long bones and "telephone receiver–shaped" bowed femurs
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Histologic Findings

Histologic evaluation of long bone structure in thanatophoric dysplasia shows disruption of endochondral ossification but not of periosteal ossification.

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Contributor Information and Disclosures
Author

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Luis O Rohena, MD Chief, Medical Genetics, San Antonio Military Medical Center; Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Assistant Professor of Pediatrics, University of Texas Health Science Center at San Antonio

Luis O Rohena, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American College of Medical Genetics and Genomics, American Society of Human Genetics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors M Carter, MS, and Susan J Gross, MD, FRCS(C), FACOG, FACMG, to the original writing and development of this article.

References
  1. Martínez-Frías ML, Egüés X, Puras A, Hualde J, de Frutos CA, Bermejo E, et al. Thanatophoric dysplasia type II with encephalocele and semilobar holoprosencephaly: Insights into its pathogenesis. Am J Med Genet A. 2011 Jan. 155A(1):197-202. [Medline].

  2. Naveen NS, Murlimanju BV, Kumar V, Pulakunta T. Thanatophoric dysplasia: a rare entity. Oman Med J. 2011 May. 26(3):196-7. [Medline]. [Full Text].

  3. Nikkel SM, Major N, King WJ. Growth and development in thanatophoric dysplasia - an update 25 years later. Clin Case Rep. 2013 Dec. 1 (2):75-8. [Medline]. [Full Text].

  4. Baker KM, Olson DS, Harding CO, Pauli RM. Long-term survival in typical thanatophoric dysplasia type 1. Am J Med Genet. 1997 Jun 27. 70(4):427-36. [Medline].

  5. Cohen MM Jr. Cloverleaf skulls: etiologic heterogeneity and pathogenetic variability. J Craniofac Surg. 2009 Mar. 20 Suppl 1:652-6. [Medline].

  6. Chitty LS, Mason S, Barrett AN, et al. Non-invasive prenatal diagnosis of achondroplasia and thanatophoric dysplasia: next-generation sequencing allows for a safer, more accurate, and comprehensive approach. Prenat Diagn. 2015 Jul. 35 (7):656-62. [Medline].

  7. [Guideline] Cunniff C. Prenatal screening and diagnosis for pediatricians. Pediatrics. 2004 Sep. 114(3):889-94. [Medline].

  8. Blaas HG, Vogt C, Eik-Nes SH. Abnormal gyration of the temporal lobe and megalencephaly are typical features of thanatophoric dysplasia and can be visualized prenatally by ultrasound. Ultrasound Obstet Gynecol. 2012 Feb 28. [Medline].

  9. Wang DC, Shannon P, Toi A, et al. Temporal lobe dysplasia: a characteristic sonographic finding in thanatophoric dysplasia. Ultrasound Obstet Gynecol. 2014 Nov. 44 (5):588-94. [Medline].

  10. Ulla M, Aiello H, Cobos MP, Orioli I, García-Mónaco R, Etchegaray A, et al. Prenatal diagnosis of skeletal dysplasias: contribution of three-dimensional computed tomography. Fetal Diagn Ther. 2011. 29(3):238-47. [Medline].

  11. MacDonald IM, Hunter AG, MacLeod PM, MacMurray SB. Growth and development in thanatophoric dysplasia. Am J Med Genet. 1989 Aug. 33(4):508-12. [Medline].

  12. Karczeski B, Cutting GR. Thanatophoric Dysplasia. GeneReviews. Available at http://www.ncbi.nlm.nih.gov/books/NBK1366/. Accessed: September 1, 2009.

  13. Li D, Liao C, Ma X. Prenatal diagnosis and molecular analysis of type 1 thanatophoric dysplasia. Int J Gynaecol Obstet. 2005 Dec. 91(3):268-70. [Medline].

  14. Liboi E, Lievens P.M-J. Thanatophoric dysplasia. Orphanet encyclopedia. Available at http://www.orpha.net/data/patho/GB/uk-Thanatophoric-dysplasia.pdf. Accessed: September 1, 2009.

  15. Sahinoglu Z, Uludogan M, Gurbuz A. Prenatal diagnosis of thanatophoric dysplasia in the second trimester: ultrasonography and other diagnostic modalities. Arch Gynecol Obstet. 2003 Nov. 269(1):57-61. [Medline].

  16. Simsek M, Al-Gazali L, Al-Mjeni R. Improved diagnosis of a common mutation (R248C) in the human growth factor receptor 3 (FGFR3) gene that causes type I Thanatophoric dysplasia. Clin Biochem. 2003 Mar. 36(2):151-3. [Medline].

  17. Thanatophoric dysplasia. Genetics Home Reference. Available at http://ghr.nlm.nih.gov/condition=thanatophoricdysplasia. Accessed: September 1, 2009.

  18. Thanatophoric Dysplasia, Type I; TD1. Online Mendelian Inheritance in Man. Available at http://www.ncbi.nlm.nih.gov. Accessed: September 1, 2009.

  19. Thanatophoric Dysplasia, Type II; TD2. Online Mendelian Inheritance in Man. Available at http://www.ncbi.nlm.nih.gov. Accessed: September 1, 2009.

  20. Vidaeff AC, Lucas MJ, Strassberg MB, Spooner KI, Ramin SM. Dichorionic twins discordant for thanatophoric dysplasia managed with selective reduction at 20 weeks' gestation: a case report. J Reprod Med. 2005 Aug. 50(8):638-42. [Medline].

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Infant with thanatophoric dysplasia. Note short-limbed dysplasia, large head, short neck, narrow thorax, short and small fingers, and bowed extremities. Radiographs demonstrate thin flattened vertebrae, short ribs, small sacrosciatic notch, extremely short long tubular bones, and markedly short and curved femora (telephone receiver–like appearance).
 
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